康复科研博士团：运动康复SCI论文导读2023-07（1）

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1.《British Journal of Sports Medicine 》  

JCR：Q1；IF：18.475

Does a corticosteroid injection plus

exercise or exercise alone add to the 

effect of patient advice and a heel cup 

for patients with plantar fasciopathy? 

A randomised clinical trial

皮质类固醇注射加运动或单独运动是否会增加患者建议和足底筋膜病患者脚跟杯的效果？一项随机临床试验

【Abstract】

Objective：To compare the effectiveness of patient advice plus heel cup alone (PA) versus PA and lower limb exercise (PAX) versus PAX plus corticosteroid injection (PAXI) to improve self-reported pain in patients with plantar fasciopathy.

Methods：We recruited 180 adults with plantar fasciopathy confirmed by ultrasonography for this prospectively registered three-armed, randomised, single-blinded superiority trial. Patients were randomly allocated to PA (n=62), PA plus self-dosed lower limb heavy–slow resistance training consisting of heel raises (PAX) (n=59), or PAX plus an ultrasound-guided injection of 1 mL triamcinolone 20 mg/mL (PAXI) (n=59). The primary outcome was changed in the pain domain of the Foot Health Status Questionnaire (ranging from 0 ‘worst’ to 100 ‘best’) from baseline to the 12-week follow-up. The minimal important difference in the pain domain is 14.1 points. The outcome was collected at baseline and at 4, 12, 26, and 52 weeks.

Results：The primary analysis found a statistically significant difference between PA and PAXI after 12 weeks favouring PAXI (adjusted mean difference: −9.1 (95% CI −16.8 to −1.3; p=0.023)) and over 52 weeks (adjusted mean difference: −5.2 (95% CI −10.4 to −0.1; p=0.045)). At no follow-up did the mean difference between groups exceed the pre-specified minimal important difference. No statistically significant difference was found between PAX and PAXI or between PA and PAX at any time.

Conclusions：No clinically relevant between-group differences were found after 12 weeks. The results indicate that combining a corticosteroid injection with exercise is not superior to exercise or no exercise.

【摘要】  

目的：比较患者建议加单独足跟杯（PA）与PA和下肢运动（PAX）与PAX加皮质类固醇注射（PAXI）改善足底筋膜病患者自我报告疼痛的有效性。

方法：我们招募了180名超声证实的足底筋膜病成人，进行这项前瞻性注册的三臂、随机、单盲优势试验。患者被随机分配到PA（n = 62），PA加自给药下肢重慢阻力训练，包括足跟抬高（PAX）（n = 59），或PAX加超声引导注射1 mL曲安奈德20mg / mL（PAXI）（n = 59）。从基线到0周随访，足部健康状况问卷的疼痛领域（范围从100“最差”到12“最佳”）的主要结局发生了变化。疼痛领域的最小重要差异是14.1分。在基线和4、12、26和52周收集结局。

结果：初步分析发现，在12周后，PA和PAXI之间存在统计学上的显着差异，有利于PAXI（调整后均数差：-9.1（95%CI -16.8至-1.3;p=0.023））和超过52周（校正均数差：-5.2（95%CI -10.4至-0.1;p=0.045））。在随访中，组间的平均差均未超过预先指定的最小重要差额。在任何时候，PAX和PAXI之间或PAX和PAX之间都没有统计学上的显着差异。

结论：12周后未发现临床相关的组间差异。结果表明，皮质类固醇注射与运动相结合并不优于运动或不运动。

2.《Journal of Physiotherapy》

JCR：Q1；IF：12.1

High-velocity power training has 

similar effects to traditional resistance 

training for functional performance in 

older adults: a systematic review

高速力量训练在老年人功能表现方面与传统阻力训练具有相似的效果：系统评价

【Abstract】

Questions：What is the effect of high-velocity power training (HVPT) compared with traditional resistance training (TRT) on functional performance in older adults? What is the quality of intervention reporting for the relevant literature?

Design：Systematic review and meta-analysis of randomised controlled trials.

Participants：Older adults (aged > 60 years), regardless of health status, baseline functional capacity or residential status.

Interventions：High-velocity power training with the intent to perform the concentric phase as quickly as possible compared with traditional moderate-velocity resistance training performed with a concentric phase of ≥ 2 seconds.

Outcome measures：Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), five times sit-to-stand test (5-STS), 30-second sit-to-stand test (30-STS), gait speed tests, static or dynamic balance tests, stair climb tests and walking tests for distance. The quality of intervention reporting was assessed with the Consensus on Exercise Reporting Template (CERT) score.

Results：Nineteen trials with 1,055 participants were included in the meta-analysis. Compared with TRT, HVPT had a weak-to-moderate effect on change from baseline scores for the SPPB (SMD 0.27, 95% CI 0.02 to 0.53; low-quality evidence) and TUG (SMD 0.35, 95% CI 0.06 to 0.63; low-quality evidence). The effect of HVPT relative to TRT for other outcomes remained very uncertain. The average CERT score across all trials was 53%, with two trials rated high quality and four rated moderate quality.

Conclusion：HVPT had similar effects to TRT for functional performance in older adults, but there is considerable uncertainty in most estimates. HVPT had better effects on the SPPB and TUG, but it is unclear whether the benefit is large enough to be clinically worthwhile.

【摘要】  

问题：与传统阻力训练（TRT）相比，高速力量训练（HVPT）对老年人功能表现有什么影响？相关文献的干预报告质量如何？

设计：随机对照试验的系统评价和荟萃分析。

参与者：老年人（>60岁），无论健康状况，基线功能能力或居住状况如何。

干预：高速功率训练，目的是尽快执行同心相位，与以≥ 2秒的同心阶段进行的传统中等速度阻力训练相比。

结果测量：短体能电池（SPPB），定时起床测试（TUG），五次坐到站测试（5-STS），30秒坐到站测试（30-STS），步态速度测试，静态或动态平衡测试，楼梯攀爬测试和步行距离测试。使用运动报告模板共识（CERT）评分评估干预报告的质量。

结果：纳入1项试验，共055名受试者。与TRT相比，HVPT对SPPB（SMD 0.27，95%CI 0.02至0.53;低质量证据）和TUG（SMD 0.35，95%CI 0.06至0.63;低质量证据）基线评分的变化有弱至中度影响。HVPT相对于TRT对其他结局的影响仍然非常不确定。所有试验的平均CERT评分为53%，其中两项试验被评为高质量，四项试验被评为中等质量。

结论：HVPT对老年人功能表现的影响与TRT相似，但大多数估计存在相当大的不确定性。HVPT对SPPB和TUG有更好的效果，但尚不清楚其益处是否足够大，在临床上是值得的。

Pain catastrophising and kinesiophobia 

mediate pain and physical function 

improvements with Pilates exercise in 

chronic low back pain: a mediation 

analysis of a randomised controlled trial

疼痛灾难化和运动恐惧症通过普拉提运动介导疼痛和身体功能的改善慢性腰痛：随机对照试验的中介分析

【Abstract】

Questions：How much are the reductions in pain intensity and improvements in physical function from Pilates exercise mediated by changes in pain catastrophising and kinesiophobia?

Design：This was a secondary causal mediation analysis of a four-arm randomised controlled trial testing Pilates exercise dosage (once, twice or thrice per week) against a booklet control.

Participants：Two hundred and fifty-five people with chronic low back pain.

Data analysis：All analyses were conducted in R software (version 4.1.2) following a preregistered analysis plan. A directed acyclic graph was constructed to identify potential pre-treatment mediator-outcome confounders. For each mediator model, we estimated the intervention-mediator effect, the mediator-outcome effect, the total natural indirect effect (TNIE), the pure natural direct effect (PNDE), and the total effect (TE).

Results：Pain catastrophising mediated the effect of Pilates exercise compared with control on the outcomes pain intensity (TNIE MD –0.21, 95% CI –0.47 to –0.03) and physical function (TNIE MD –0.64, 95% CI –1.20 to –0.18). Kinesiophobia mediated the effect of Pilates exercise compared with control on the outcomes pain intensity (TNIE MD –0.31, 95% CI –0.68 to –0.02) and physical function (TNIE MD –1.06, 95% CI –1.70 to –0.49). The proportion mediated by each mediator was moderate (21 to 55%).

Conclusion：Reductions in pain catastrophising and kinesiophobia partially mediated the pathway to improved pain intensity and physical function when using Pilates exercise for chronic low back pain. These psychological components may be important treatment targets for clinicians and researchers to consider when prescribing exercise for chronic low back pain.

【摘要】  

问题：普拉提运动对疼痛强度的降低和身体机能的改善在多大程度上是由疼痛灾难和运动恐惧症的变化介导的？

设计：这是一项四臂随机对照试验的二级因果中介分析，测试普拉提运动剂量（每周一次、两次或三次）与小册子对照。

参与者：255名慢性腰痛患者。

数据分析：所有分析均按照预先注册的分析计划在R软件（版本4.1.2）中进行。构建有向无环图以识别潜在的治疗前介质-结局混杂因素。对于每个中介模型，我们估计了干预-中介效应、中介-结果效应、总自然间接效应（TNIE）、纯自然直接效应（PNDE）和总效应（TE）。

结果：与对照组相比，疼痛灾难性因素介导普拉提运动对疼痛强度（TNIE MD -0.21，95%CI -0.47至-0.03）和身体功能（TNIE MD -0.64，95%CI -1.20至-0.18）的影响。与对照组相比，运动恐惧症介导了普拉提运动对疼痛强度（TNIE MD -0.31，95%CI -0.68至-0.02）和身体功能（TNIE MD -1.06，95%CI -1.70至-0.49）结局的影响。每个调解员调解的比例适中（21%至55%）。

结论：使用普拉提运动治疗慢性腰痛时，疼痛灾难性和运动恐惧症的减少部分介导了改善疼痛强度和身体功能的途径。这些心理成分可能是临床医生和研究人员在为慢性腰痛开具运动处方时要考虑的重要治疗目标。